Congenital femoral deficiencies remain a surgical challenge. There is no common classification: both radiological and clinical methods are recommended. Depending on the severity of the deformity, reconstructive and lengthening techniques are performed, while accompanying deformations are taken into consideration. In addition, amputation or fusion techniques together with orthotic devices are used. A total of 35 patients (37 extremities) with congenital femoral deficiencies have been treated at the Orthopaedic Hospital Vienna-Speising, from 1982 to 1998. 24 extremities were treated with reconstructive and/or lengthening techniques. Results and complications are reported.